Hospice Care, Rather Than Aggressive Treatment, Found Better for End-of-Life

Families may be more satisfied with end-of-life care for loved ones dying of cancer when treatment is focused on comfort rather than aggressive treatment and provided outside of a hospital, a U.S. study suggests.

When patients received at least three days of hospice care focused on comfort and quality of life, 59 percent of their loved ones thought their treatment was excellent, compared with just 43 percent when patients received little or no hospice care, the study found.

At the same time, family members of cancer patients admitted to an intensive care unit (ICU) in the last month of life reported excellent care just 45 percent of the time, compared with 52 percent when patients didn’t receive this type of aggressive treatment.

“Interventions should focus more on increasing early hospice enrollment and decreasing ICU admissions and hospital deaths,” said lead study author Dr. Alexi Wright of Harvard Medical School and Dana-Farber Cancer Institute in Boston.

“The best way to do this is to encourage patients, physicians and family members to talk about their end-of-life wishes,” Wright added by email.

Many patients with advanced cancer receive aggressive medical care during their dying days even though growing evidence suggests that high-intensity treatments may not be associated with better quality of life or outcomes for patients, or an easier bereavement for the loved ones they leave behind, Wright and colleagues report in JAMA.

For the current study, researchers interviewed family members and close friends of 1,146 patients aged 65 and older who died of lung or colorectal cancers.

In most patients, the cancer had spread beyond the original location to other tissue and organs.